Musings in the life of an internist, cardiologist and cardiac electrophysiologist.

Tuesday, June 09, 2009

A Defibrillator In Action

If you ever wonder why I do what I do, there's probably no better example than to see 20 year old Belgian soccer player Anthony Van Loo saved by his implantable cardiac defibrillator (ICD):

In this video, Van Loo is seen walking from the field and then collapsing at 7 seconds, his legs are seen twitching at 15 seconds as his automatic defibrillator fires to restore his heart rhythm to normal, and then by 21 seconds after the event he regains conciousness and sits up. According to some reports, Van Loo was not allowed to return to soccer unless he had an ICD implanted due to his known cardiac disorder.

Despite all of the press out there, this is NOT a heart attack, but rather the result of a life-threatenting heart rhythm disorder like ventricular fibrillation or ventricular tachycardia. In young people, the cause of these life-threatening arrhythmias include right ventricular dysplasia, catecholamine-induced ventricular tachycardia, idiopathic cardiomyopathy, and long QT syndrome (to name just a few). At maximum output, a defibrillator can deliver about 830 volts in a tenth of a second to restore the heart rhythm back to normal.

16 comments:

Wow. Seeing someone defibrillated is like witnessing a miracle, even when the patient doesn't regain consciousness, but I've never seen anything quite like that! Cool! You guys truly do make miracles happen after putting in those ICDs.

Any idea if the need for the ICD was discovered by an ECG given as a part of a sports physical? I have heard that sports related cardiac fatalities dropped about 90% after Italy mandate an ECG as a part of a mandatory sports physical.

Cardiovascular screening recommendations for athletes differ between the US and Europe as you mention. Certainly, something came to doctors' attention to recommend an ICD before Van Loo returned to soccer, but whether than was an arrhythmia, an episode of prior aborted sudden death, or an abnormal EKG/extended monitoring is unknown to me.

Does he know he was defibrillated? From data from the implant, I mean.Does it have any feedback method so he knows WHY he just fell down and got back up? Or does this information only become available after a trip to the hospital?

I suspect he knew something was coming as he walked off the field, and waking after the event with people surrounding you is a pretty big clue that his implantable cardiac defibrillator (ICD) went off.

Interestingly, all ICD's store the signal they treated and the type of therapy(ies) delivered in their memory for later recall by medical personnel. This way, adjustments or new therapy can be administered, if needed.

In the US he would head to the closest Emergency Department. If it is a large hospital and he has a common ICD they can probably read the ICD data immediately. If it is a smaller hospital or if it is after regular business hours he will wait in the ED (hours) or be admitted to the hospital (overnight) until a rep. can arrive with the proper equipment to read the data from the ICD.

So that's what I looked like. My device told us I went into cardiac arrest a while back, but I was defibrillated while under water. One second I felt syncope coming on, the next I was wondering why I was holding my breath for so long. Like that guy, I felt perfectly fine afterward, very upset about what had happened, but fine.

my defib has gone off twice. once last night. was on a bike ride and decided to test myself on a 15 minute hill climb. obviously my heart rate got too high and i got zapped. the first time it happened, about a year ago, it was, also, when i was on my bike. it was a huge shock. this time, i wasn't (quite) as stunned, but it still knocked me down.

as a former world class age group triathlete, it's hard to slow down. also, i can't find any heart rate monitors that work for me so i can't keep my HR in the zone it should be.

Modern devices should have an algorhythm that discriminates between the high heart rates of exercise and dangerous tachy arrhythmias. For example, the PR logic algorhythm used by Medtronic. Don, If your ICD is zapping you when you exercise, you should talk to your rep about SVT discrimination, and maybe consider upgrading at the next "battery" change.

About Me

Westby G. Fisher, MD, FACC is a board certified internist, cardiologist, and cardiac electrophysiologist (doctor specializing in heart rhythm disorders) practicing at NorthShore University HealthSystem in Evanston, IL, USA and is a Clinical Associate Professor of Medicine at University of Chicago's Pritzker School of Medicine. He entered the blog-o-sphere in November, 2005.
DISCLAIMER: The opinions expressed in this blog are strictly the those of the author(s) and should not be construed as the opinion(s) or policy(ies) of NorthShore University HealthSystem, nor recommendations for your care or anyone else's. Please seek professional guidance instead.